Clinical Dilemmas in Viral Liver Disease

 

Description:

The only evidence-based book to approach viral liver disease by focusing exclusively on the clinical dilemmas encountered by hepatologists and their medical teams

Although viral hepatitis is a growing public health risk around the world, the World Health Organization (WHO) views the elimination of hepatitis infection over the next several as an achievable goal. Effective pharmaceutical therapies are now available, yet medical teams caring for patients with viral hepatitis are challenged when looking for answers to specific questions in the current medical literature. The second edition of Clinical Dilemmas in Viral Liver Disease provides evidence-based guidance for medical teams involved in diagnosing, treating, and managing patients with viral liver disease.

This fully updated book explores developments in new treatments and new diagnostic approaches that are contributing to WHO goals of viral elimination. Brief, easily referenced chapters examine clearly defined topics, addressing the clinical questions and difficulties encountered by medical teams in day-to-day practice. Contributions by an international team of investigators and clinicians address clinical questions and issues which are seldom found in standard textbooks and online repositories. Offering practical guidance on the specific challenges and dilemmas of treating viral liver disease, this unique volume: 

Provides practical, evidence-based guidance on topical and controversial issues

Addresses understudied questions that arise in day-to-day clinical practice

Discusses the challenges surrounding global elimination programs

Presents focused approach that is supported by current literature and expert opinion

The second edition of Clinical Dilemmas in Viral Liver Disease is required reading for practicing and trainee hepatologists, gastroenterologists, transplant surgeons, virologists, and other practitioners involved in caring for patients with liver disease.

 

Table of Contents:

 

PART I: Investigating the Liver

1 Noninvasive markers of fibrosis: how reliable are they?

Introduction

Currently available noninvasive methods

Diagnostic performance of noninvasive methods for diagnosing cirrhosis

Use in clinical practice

Conclusions and perspectives

References

2 Liver biopsy in chronic viral hepatitis: is there still life left in it?

Liver biopsy

Serologic markers

Imaging alternatives to liver biopsy

Guidelines

What is the trend?

Is biopsy needed for the complications of chronic viral hepatitis?

Is there still life in it?

References

3 Screening for hepatocellular carcinoma in viral liver disease: any new biomarkers on the horizon?

Introduction

References

4 Realistic estimates of hepatitis C virus and hepatitis B virus disease burden

Introduction

References

PART II: Today's Therapies

Section 1: HCV

5 Acute hepatitis C: treat immediately or give a chance to spontaneously clear?

Introduction

Defining acute hepatitis C infection

Risk factors for evolution of chronic infection

Acute hepatitis C increasing due to opioid epidemic

Treatment response rates in acute relative to chronic hepatitis C

Arguments to treat or not to treat in acute hepatitis C (Table 5.1)

Postexposure prophylaxis (PEP)

Practical approach to decision making in acute hepatitis C

References

6 Is ribavirin alive or dead in the current era of HCV therapy?

Introduction

Ribavirin in the interferon era

Ribavirin in the era of all‐oral DAAs

Conclusion

References

7 Hepatitis C virus genotype and viral testing, and on‐treatment monitoring: necessary or overkill?

Introduction

Current recommendations on diagnosis and treatment monitoring for HCV infection

Proposed framework for simplified HCV infection management (Figure 7.1)

Conclusion

References

8 Treatment of hepatitis C virus in renal disease: can we use all the drugs without additional monitoring?

Introduction

DAA metabolism and general recommendations

Non‐sofosbuvir recent results

Sofosbuvir‐based regimen and renal safety

Conclusion

References

9 Does directly acting antiviral therapy improve quality of life?

Introduction

Health‐related quality of life in chronic hepatitis C infection

Direct‐acting antiviral therapy and health‐related quality of life

Conclusion

References

10 Morbid obesity and hepatitis C: treat as normal or are there additional issues to consider?

Obesity as a health problem

Obesity‐related comorbidities

Assessment of fibrosis in obese patients

Obesity and sustained virologic response with interferon therapies

Obesity and SVR in the new direct‐acting antivirals

Obesity as a predictor of fibrosis progression beyond SVR

Conclusion

References

11 Generic direct‐acting antiviral agents: do they work well?

Introduction

Access to generic DAAs

Bioequivalent pharmacokinetics for generic and originator DAAs

Results of generic DAAs by country

Buyers’ club global access programs

Results of generic DAA by genotype, cirrhosis and treatment regimen – comparison with clinical trial data

Conclusion

References

12 Impact and management of patients with multiple hepatitis C virus genotypes

Introduction

Extent of the problem

Chimeric hepatitis C virus

Clinical implications of infection with multiple genotypes

Conclusion

References

13 Hepatitis C virus and injecting drug use: what are the challenges?

Introduction

Challenge 1: Identification of those with cirrhosis

Challenge 2: Halting the spread of HCV

Challenge 3: Providing treatment as prevention

Challenge 4: Poor linkage to care

Challenge 5: Reinfection

Challenge 6: Standard models of care are not suited for PWID

Conclusion

References

14 Hepatitis B virus reactivation while on hepatitis C virus direct‐acting antiviral therapy: is that a real concern and when is it a concern?

Introduction

Prevalence of HCV/HBV coinfection

Definition of HBV infection

Definitions of HBV reactivation and clinically significant adverse events

HBV reactivation among persons with chronic HBV

HBV reactivation among persons with resolved HBV

Recommendations for clinical practice

Conclusion

References

15 Drug–drug interactions with direct‐acting antivirals: when do we need to care?

Introduction

Mechanisms of Drug–Drug Interactions

Pharmacology of individual directly acting antivirals

Drug–drug interaction advice for specific therapeutic areas

Conclusion

References

16 Treatment of hepatitis C in children

Introduction

Principles of treatment

General management

Conclusion

References

17 While direct‐acting antivirals are effective, are there any unique safety considerations?

Introduction

Safety profile of DAAs

Significant drug–drug interactions

Conclusion

References

18 Harm reduction strategies to prevent new infections and reinfections among people who inject drugs: how effective are they?

Introduction

Risk factors for HCV acquisition among people who inject drugs

Definitions of viral relapse and reinfection

Strategies to reduce HCV (re)infection among PWID

Treatment as prevention and the impact of reinfection

Practical approaches to prevent HCV infection and reinfection among PWID

References

19 Hepatitis C virus therapy in advanced liver disease: treat or transplant and treat?

Introduction

Efficacy and safety of treatment before liver transplantation

Efficacy and safety of treatment after liver transplantation

Controversies in the timing of HCV treatment of patients with decompensated cirrhosis

Conclusion

References

20 Hepatocellular carcinoma and hepatitis C virus: which should be treated first?

Introduction

Treatment of HCV before tumor eradication

Treatment of HCV after tumor eradication

Conclusion

References

21 Should we incentivize patients to take hepatitis C virus therapy?

Introduction

Conclusion

References

22 Treating prisoners with hepatitis C: should we do it and how?

Introduction

Response

Challenges and solutions

Conclusion

Acknowledgments

References

23 Use of hepatitis C virus‐positive organs for uninfected recipients in the era of effective and safe direct‐acting antivirals: pros and cons

Introduction

Definitions

Use of organs from HCV‐positive donors in HCV‐negative recipients

Treatment and ethical concerns

Current and future perspectives

References

24 Is real‐life hepatitis C virus therapy as effective as in clinical trials?

References

Section 2: HBV, HDV, and HEV

25 Management of acute hepatitis B infection: when should we offer antiviral therapy?

Introduction

Rationale for treatment of acute HBV infection

Viral kinetics of acute HBV infection

Antiviral options for acute HBV infection

Antiviral therapy to improve liver function in acute HBV

Antiviral therapy to prevent chronic infection in acute HBV

Discussion

Conclusion

References

26 Rethinking the inactive carrier state: management of patients with low‐replicative HBeAg‐negative chronic hepatitis B and normal liver enzymes

Introduction

Definition of normal ALT levels

Hepatitis B virus DNA levels

Serum HBsAg levels

Hepatitis B core‐related antigen

Fibrosis evaluation and noninvasive markers

Natural history

Therapy

References

27 Hepatitis B e antigen‐positive chronic hepatitis B infection with minimal changes on liver biopsy: what to do next

Conclusion

References

28 The management of hepatitis B virus in pregnancy

Prevention of hepatitis B virus transmission by vaccination

Antiviral prophylaxis for high viral load mothers

Hepatitis flare after stopping antiviral therapy

Safety of antiviral drugs during pregnancy and breastfeeding

References

29 Treatment of hepatitis B in children

References

30 Hepatitis B vaccine failures: how do we handle them?

Introduction

History

Definition of nonresponse to immunization

Risk factors for nonresponse to vaccination

Ways to approach nonresponse to conventional immunization against HBV

Vaccine adjuvants and immune stimulators

References

31 The stopping rules in hepatitis B virus therapy: can we provide any guidance?

The dilemma: effective control but little cure in chronic hepatitis B

How may discontinuation of antiviral treatment increase immune control?

Stopping NA treatment after achieving serologic endpoints

Inducing serologic response by stopping NA treatment in HBeAg‐negative patients

How can response to NA discontinuation be predicted?

Management of harmful ALT flares after NA discontinuation

Guidance for stopping NA treatment

Future perspectives on the role of NA discontinuation for HBV treatment

References

32 Hepatitis C and hepatitis B coinfection

Introduction

Clinical impact of HCV/HBV coinfection

Evaluation and treatment of HCV and HBV coinfection (Table 32.1)

Treatment of subjects with HCV/HBV coinfection using PEG‐IFN and RBV

Treatment of HBV and HCV coinfection in the era of DAA

Improvement in clinical outcomes

Updated international guidance on the treatment of patients with HCV and HBV coinfection

Conclusion and Future Directions

Acknowledgments

References

33 Chronic hepatitis E virus infection: is it reality or hype and where does it matter?

Introduction

Chronic HEV infection among solid organ transplant patients

Chronic HEV infection among HIV‐positive patients

Management of chronic HEV infection

Conclusion

References

34 Hepatitis E virus vaccines: have they arrived – when, where and for whom?

Introduction

Principles underlying HEV vaccines

Human studies with HEV vaccines: efficacy and safety

Indications for use of HEV vaccine

Conclusion

References

PART III: Clinical Set‐up and the Future

35 Do we need expert hepatitis C virus treaters or are amateur treaters good enough?

References

36 Hepatitis C vaccines: how close are we to the promised land?

The need for an HCV vaccine

HCV vaccine rationale: insights from natural infection and animal studies

Generating anti‐HCV immunity with vaccines

Universal HCV vaccines to target multiple genotypes

Combining antibody and T‐cell components in rational vaccine design

Remaining challenges to overcome in HCV vaccine development

Acknowledgments

References

37 Elimination of hepatitis C virus in high‐prevalence, low‐income countries: is it feasible?

The hope

The barriers

Pursuit of a model of care: the Egyptian experience

Conclusion

References

38 Hepatitis B virus diagnostics: anything new?

Introduction

Hepatitis B surface antigen

Quantitative HBV DNA testing

Covalently closed circular DNA

Hepatitis B e antigen and antibody

Hepatitis B core antigen and core‐related antigen

Quantitative HBV RNA

Hepatitis B core antibody

Hepatitis B surface antibody

HBV genotypes and subtypes

Precore and basal core mutations

Biomarkers associated with risk for progression

Future perspectives

Conclusion

References

PART IV: Ongoing Controversies

39 Is hepatocellular carcinoma risk impacted favorably or unfavorably by hepatitis C virus therapy with direct‐acting antivirals?

References

40 Global elimination of hepatitis C virus by 2030: the optimistic view

Introduction

Infectious diseases elimination and HCV elimination as a global target

Progress towards HCV elimination targets

Strategies required to enhance global HCV elimination efforts

Reasons for optimism

References

41 Global elimination of hepatitis C virus by 2030: the pessimistic view

Introduction

Underdiagnosis of HCV infection

Inadequate prevention strategies

Undertreatment of HCV infection

Conclusion

References

Index

End User License Agreement

 

An aparitie	22 April 2020
Autor	K. Rajender Reddy, Graham R. Foster
Dimensiuni	18.54 x 1.78 x 23.37 cm
Editura	Wiley-Blackwell
Format	Paperback
ISBN	9781119533399
Limba	Engleza
Nr pag	272